Prolongation of QTC interval in patients with cirrhosis

Objectives: To observe the frequency of QTc [corrected QT] interval prolongation in patients with chronic liver disease in our population

Study design: A cross-sectional analytical study

Place and duration: Department of Gastroenterology, Liaquat National Hospital and Medical College, Karachi from May 2009 to October 2009

Methodology: A non- probability, purposive sampling is used in already diagnosed cirrhotic patients. Patients between 25-70 years were included. These patients were divided into three groups according to their Child-Pugh [C.P.] classification [class A, class B and class C]. An electrocardiogram [ECG] of all patients was obtained and QT intervals corrected for heart rate [QTc] were calculated. Analysis of data was done by SPSS 17

Results: 121 cirrhotic patients were inducted in this study. 10 patients belonged to C.P. class A, 49 to C.P. class B, and 62 to C.P. class C. Prolonged QTc interval was observed in 48 [39.7%] patients while in 73 [60.3%] patients QTc interval was normal. Occurrence of prolonged QTc interval was greater in C.P. class-C [50%] followed by C.P. class-B [30.6%], p value 0.045 and 0.016 respectively

Conclusion: Significant number of cirrhotic patients had prolonged QTc interval and this prolongation of QTc interval was directly associated with more advanced liver disease

Helicobacter pylori infection; dyspeptic patients undergoing endoscopy: a hospital based study

To determine the frequency of H. pylori infection in dyspeptic patients undergoing endoscopy at a tertiary care center in Karachi. Patients undergoing endoscopy at Liaquat National Hospital, Karachi. Cross sectional descriptive study. Department of Gastroenterology, Liaquat National Hospital, Karachi. May 2008-October 2008. All adult patients with symptoms of dyspepsia for more than 1 month duration were included. Patients with upper gastrointestinal bleed, anemia or weight loss were excluded. Upper gastrointestinal endoscopy was performed in all patients and biopsy specimens two each from antrum and body and one from fundus were taken for histology. A total of 123 dyspeptic patients were included in the study. 76 [61.8%] patients were males and 47 [38.2%] were females. H pylori was detected in mucosa of 49 [39.8%] patients. The mean age of the patients was 41.41 +/- 13.15 Years [95%CI; 39.06 to 43.75]. Rate of H.pylori infection was not found statistical significant with age, gender, duration of symptoms and BMI. The prevalence of H pylori infection in dyspeptic patients was lower than reported in previous studies from other centers in Pakistan. Other environmental factors should be evaluated in every patient especially who is negative for H. pylori in our setup

Familial adenomatous polyposis

Familial adenomatous polyposis represents approximately 1% of all colorectal tumours and is caused by germline mutations in the adenomatous polyposis coli [ARC] gene. A 38-year-old lady presented with abdominal pain, diarrhoea and iron deficiency anemia. There was no history of colorectal cancer in the family Colonoscopy showed hundreds of polyps throughout the colon sparing the rectum, and an ulcerative tumour of the sigmoid colon. The diagnosis was familial adenomatous polyposis [FAR] and adenocarcinoma of the sigmoid colon. Colectomy with ileorectal anastomosis was performed and later on she was given chemotherapy and advice life long surveillance. The patient had one brother and one sister, without clinical symptoms. The brother had a single hyperplastic rectal polyp, while the sister refused colonoscopy. The patient has 2 sons, the elder son had normal colonoscopic findings, and the younger son was also diagnosed as a patient of FAR and referred for colectomy

Transjugular intrahepatic portosystemic stenting in portal hypertensive gastropathy

Portal Hypertensive Gastropathy [PHG] is a rare cause of upper gastrointestinal bleeding in patients with Chronic Liver Disease [CLD]. This is the case report of a 46-year-old female known case of Hepatitis C Virus [HCV] CLD, who presented with melena and coffee ground vomitings for 6 months. Esophagogastroduodenoscopy [EGD] showed PHG while an ultrasound revealed chronic liver disease. The patient had a history of repeated blood transfusions over the last 6 months. She was given propanolol but no benefit occurred. She was referred for transjugular intrahepatic portosystemic stenting [TIPSS] to an interventional radiologist, which was followed by a reduction in PHG and the need for transfusion

Appraisal of the knowledge of internet users of Pakistan regarding hepatitis using on line survey

Hepatitis B and hepatitis C are global health care problems causing morbidity and mortality. Much of it could be prevented by better education of the masses regarding its spread. The study was conducted to assess the knowledge base of internet users of Pakistan to help in formulating education strategies. A survey questionnaire consisting of 20 close ended questions was designed and hosted on a website. The responses submitted at the website were auto-emailed to the author. A total of 1024 complete responses were included. The survey shows increased level of awareness according to the educational status. The knowledge status of lowest education level was also adequate possibly due to access to internet to these respondents. Internet users in Pakistan have adequate core knowledge regarding hepatitis